Provider Demographics
NPI:1598745176
Name:MAGILL, BRANDON ROBERT (DMD)
Entity Type:Individual
Prefix:DR
First Name:BRANDON
Middle Name:ROBERT
Last Name:MAGILL
Suffix:
Gender:M
Credentials:DMD
Other - Prefix:
Other - First Name:
Other - Middle Name:
Other - Last Name:
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Other - Credentials:
Mailing Address - Street 1:8108 CAZENOVIA RD
Mailing Address - Street 2:7 PINES OFFICE PARK BLDG 2
Mailing Address - City:MANLIUS
Mailing Address - State:NY
Mailing Address - Zip Code:13104-9780
Mailing Address - Country:US
Mailing Address - Phone:315-682-8921
Mailing Address - Fax:315-682-5561
Practice Address - Street 1:8108 CAZENOVIA RD
Practice Address - Street 2:7 PINES OFFICE PARK BLDG 2
Practice Address - City:MANLIUS
Practice Address - State:NY
Practice Address - Zip Code:13104-9780
Practice Address - Country:US
Practice Address - Phone:315-682-8921
Practice Address - Fax:315-682-5561
Is Sole Proprietor?:Yes
Enumeration Date:2006-01-19
Last Update Date:2013-07-30
Deactivation Date:
Deactivation Code:
Reactivation Date:
Provider Licenses
StateLicense IDTaxonomies
NY0523321223G0001X
Provider Taxonomies
Primary?CodeTypeClassificationSpecialization
Yes1223G0001XDental ProvidersDentistGeneral Practice